Care and Control

Dividing Lines – Lyn French

Rear Window Publications
1995 ISBN 0 9521040 3 2
© Lyn French

“Through artistic expression, we can hope to keep in touch with our primitive selves whence the most intense feelings and even fearfully acute sensations derive, and we are poor indeed if we are only sane.” D.W. Winnicott

“If there is, in classical madness, something which refers elsewhere and to ‘other things,’ it is no longer because the madman comes from a world of the irrational and bears its stigmata; rather, it is because he crosses the frontiers of bourgeois order of his own accord and alienates himself outside the sacred limits of its ethics.”  Michel Foucault

Peter Cross first approached me in April 1994 to sound out the possibility of collaborating on an exhibition project, which would centre on Hackney Hospital and include contributions from both contemporary artists and mental health service users. He suggested that psychiatric service users who choose to use art processes as a way of exploring issues and emotions central to their experiences could effectively be brought into dialogue with artists who focus their work on subject areas which might overlap with, or reflect upon, what Peter perceived as the users’ concerns.

During our initial discussions we talked about the proposed exhibition in terms of what makes an individual an artist and who or what institutions support or challenge this identification; whether or not a piece of work made by a service user could be called “art,” and if the visual pieces we hoped that they would create for the exhibition were not “art,” what level could be applied; to what extent a curator could expand the boundaries defining what is commonly accepted as “an exhibition;” what our roles would be in facilitating this project, and how these roles might contradict, or support, our professional identities.

From the beginning, it was agreed that the pieces and texts produced would move beyond highlighting issues specifically related to psychiatry towards more discreet reflections on how both the individual and the collective body responds to what amounts to a loss of power in the realms of the physical, the psychological, the cultural and the political.

It seemed necessary to acknowledge the risks inherent in inviting members of the art community into a psychiatric hospital to create site-specific pieces. The subject of so-called insanity, and all that it implies, deeply intrigues and repels. Hackney Hospital can be understood to represent the “closed room” which we are forbidden to enter as children: there remains an irresistible desire to “peek in,” even though we instinctively know that we might not like what we discover. Primitive and unconscious voyeuristic desires are experienced by all of us. As workers within such an institution and as outsiders invited in, it is our responsibility to be aware of their seductive power. Our challenge in developing Care and Control was to try to ensure that we did not “stage a show,” which satisfied these desires, but instead, included pieces which attempted to address this very issue.

Another area of concern centred on the hospital users’ contribution to the project. Our primary objective was to step away from the historical representation of art created by untrained individuals who were suffering from mental distress, such as the exhibitions mounted under the general heading of Art Brut or Outsiders’ Art. Our intention was to present hospital users with the opportunity to voice publicly their perspectives on aspects of psychiatric treatment, and on their experiences of the institution, in the most specific and the widest sense.

Jane Roberts and I had set up an art workshop programme in 1992, designed to complement the art therapy service I had established at the hospital. This marked the beginning of the Hackney Arts Initiative. When I first met Peter, Jane and I had recently introduced a specific theme to the workshop series. Hackney Hospital would be closing in Autumn 1995 and it seemed both appropriate and therapeutic to focus the workshop on documenting the existing site prior to its demolition. We hoped to compile an archive of images, which might incorporate a personal and political slant on users’ experiences as consumers of the psychiatric services provided by the hospital. From a clinical perspective, it seemed vital to create a forum in which users could work through a difficult and, in many instances, highly charged ending, while also confronting the loss of the hospital, which resonates for each individual in deep and powerful ways.

The vast majority of individual participating in the art workshops have been in-patients on the acute wards and many have a history of frequent admission. Their ambivalent feelings about the psychiatric treatment they have engaged in, or resisted, can only be generalised by the title of this exhibition.

Prior to the opening of the Homerton General Hospital, Hackney Hospital housed the physical and psychological departments servicing the community; many current users were themselves born in the hospital, or had close family members or friends who died there. A number of elderly members of the Hackney Hospital community can recall the days when the site operated as a Workhouse. These layered personal memories, historic and contemporary, along with the individual responses to the psychiatric institution, informed many of the early pieces created in the archive workshops run by members of the Hackney Arts Initiative.

The theme of Hackney Hospital’s pending closure was identified as the most logical point for the exhibition. On a practical level, as the different wards and department based on the Hospital site would be moving to the new complex in stages commencing in April 1995, there was scope for Rear Window, in collaboration with Hackney Arts Initiative, to take over spaces as they became available.

As a group, we concluded that the core component of the proposed show would be work produced by users in the existing workshop programme.

The main debate revolved around the degree to which the workshop facilitators and artists should intervene in the production of images, object, and installations by service users. We felt that a certain level of guidance would be appropriate, but the point at which guidance might be experienced as restricting an organic process, or as overtly directive, was difficult to pin down. It was important that we did not impose our own conceptual and aesthetic agenda on the workshop participants, while being aware that effective communication hinged on the acquisition of visual language skills. Out overall aim across the workshop programme, which was carefully structured to meet the differing needs of service users, and conducted in environments ranging from studio spaces through to locked wards, was to achieve a balance between client-led exploration and the professional artists’ interventions.

It is difficult to convey the complexity of the task facing each workshop facilitator. From outside artists who joined established groups for a block of sessions to those professionals who had a long history of working at the hospital on art and art therapy based programmes, engaging on a project as ambitious as Care and Control presented many challenges. Speaking from the perspective of an artist and art therapist, I found myself struggling with issues particular to my role at the hospital; how my involvement on the project related to, or was in conflict with this role; and how my identity as an artist did, or did not fit in.

As a clinician, a recurring theme in my therapeutic work is how the individual copes with life’s significant changes and losses. Loss takes many forms, ranging from the most concrete—the death of a significant other, or the loss of a cultural or personal identity—to the sense of absence, or perceived denial, of a desired emotional experience.

The loss of the capacity to differentiate between the real and the imagined is one of the most frightening and confusing experiential states. In such instances, the boundary between outside and inside collapses. In the collective realm of experiences, the violent penetration of the one culture forcing its identity on to, or into another, represents a similar collapse of dividing lines and results in severe emotional distress.

For the artist, the experience of loss can fuel the drive to create a piece of work which might fill the gap. Marcel Proust has written:

“I had to recapture from the shade that which I had felt, to reconvert it into its psychic equivalent. But the way to do it, the only one I could see, was to create a work of art… Art is essentially a search for symbolic expression. The creation of this inner world, I contend, is unconsciously also a recreation of a lost world.”

Another compelling force behind the artist’s desire to create, as discussed in psychoanalytical literature, can be linked to the need to express aggressive and destructive impulses, and to make reparation for damage caused to internal objects in unconscious fantasy. The work of art can provide a contained for such primitive fantasies, while the process of creating art can offer a means through which harmony and integration can be achieved. The piece of work which results may or may not hold identifiable traces of the unconscious processes engaged in. Indeed, it could be said that even the artist him or herself cannot with confidence analyse the unconscious fantasies and memories which may have informed the decisions taken en route.

In her collection of essays, brought together in 1991 under the title Dream, Phantasy, and Art, Hanna Segal explores the link between the creative impulse and the means of evoking aesthetic emotion. She writes from a psychoanalytical perspective influenced by Melanie Klein’s theories. Her view is that:

“The act of creation at depth has to do with an unconscious memory of a harmonious internal world and the experience of its destruction; that is, the depressive position. The impulse is to recover and recreate this lost world. The means to achieve it has to do with the balance of ‘ugly’ elements with beautiful elements in such a way as to evoke an identification with this process in the recipient. Aesthetic experience in the recipient involves psychic work. This is what distinguishes it from pure entertainment or sensuous pleasure. And we know that people vary in their capacity to accomplish such work. Not only does the recipient identify with the creator, thereby reaching deeper feelings than he could do by himself; he also feels it is left to him to look for completion.” (Hanna Segal, Dream, Phantasy and Art, published in association with the Institute of Psychoanalysis, London, 1991.)


The artist can be said to use a specific medium both to communicate and to contain expressions of internal conflict and loss. Individuals who have not had access to ways in which to increase their understanding of painful mental states, and do not possess the language with which to articulate their experiences, are at greater risk of being overwhelmed by them.

Making available the opportunity for hospital users to discover creative rather than pathological forms of expression is one of the primary goals of the artists and art therapists who work with them.

A key feature of art therapy is to encourage clients to explore various media themselves without the active involvement of the therapist. This gives both the therapist and the client the opportunity to gain insight into how the individual copes with the anxiety inherent in confronting a new, and often very unfamiliar situation, and all of its everyday ramifications. It can be helpful if the client has little or no previous knowledge of art as this reduces the possibility of manipulating the language and provides more scope for unconscious material to surface. Not to be underestimated either is the sheer enjoyment inherent in discovering one’s own unique approach to image making. For all these reasons, teaching art techniques to clients is not the therapist’s task.

The images and processes engaged in, which evolve in the course of art therapy sessions, are used as a starting point form which to move into verbal explorations focussing on the client’s past and present life. A number of clinician and theoreticians have emphasised the similarities between creating a picture within an art therapy session and dreaming. This analogy is helpful, but the differences between the two experiences are as significant as the identified overlaps.

To focus briefly on the interface between dreaming and making an image within the therapy session, it could be said that in both instances, the subject may employ various strategies such as displacement, distortion, condensation, and symbolic representation as defined by Freud. The art therapist will facilitate the client’s interpretation of the image, in a way that is similar to how the psychoanalyst might make use of a dream related by the analysand. Interwoven in this process are the communications made through the multi-layered transference relationships the client develops with the art therapist. Such communications are also privately interpreted by the art therapist, informing his or her responses to the client, and when appropriate, are directly negotiated in the session.

The artwork produced within a therapy context is therefore experienced by both client and therapist in a way that is markedly different from pieces made in a workshop or studio setting. For these reasons, it is considered inappropriate to show the work in a public venue. However, many individuals engaging in art therapy discover the pleasure to be gained from creating objects and images and wish to develop their skills while, at the same time, actively request opportunities to exhibit their work. Equally, a number of hospital users express reluctance to engage in art therapy, as their anxieties about using the materials are too great. In response to this feedback from clients, Jane and I first introduced multi-tiered art workshop programme designed to meet these diverse needs.

In keeping with the view that a clear boundary between art and art therapy be maintained, art workshops take place, where possible, in an on-site studio setting and are facilitated by an artist, not an art therapist. This gives hospital users the choice to participate in a group conducted in a non-clinical environment and run by an outside practitioner, not a member of the hospital’s mental health team.

Following through Hackney Arts Initiative’s commitment to challenging the way in which mental health service users are perceived, Jane and I have also developed an exhibition programme, which has focused on liaising with the Whitechapel Art Gallery’s Education Department. This has resulted in two exhibitions (Inner City / Inter City, 1993 and In Transition, 1994) and a regular slot on the Whitechapel’s Homerton Gallery exhibition calendar. In addition, we are currently developing a Picture Archive of images made by users, selections of which are scheduled to be shown in the new site and in the community. The first installation of work, totalling 175 images has been hung in the new home for the elderly and opened 10 April 1995.

Collaborating with Rear Window has meant that our exhibition programme and the art workshop project, with its underlying clinical agenda, could be expanded considerably; a development which was very much welcomed. However, in order to carry the project forward, the safe sanctuary the workshop programme represented for many of its more vulnerable users had to be opened up to et in professional artists and members of a contemporary gallery organisation, all of whom operate within a specifically defined cultural community with its own highly evolved language. The willingness and courage of the workshop participants who agreed to engage in the project should be noted. Following a brief in many ways similar to the one presented to participating artists, hospital users were invited to create works, which communicated their varying responses to one specific institution—the psychiatric hospital. This has been used in the exhibition as a point of departure for reflections on more wide ranging yet interconnected subjects related to the architectural environment; the power relations inherent in institutionalised communities; and the effects of physical or mental illnesses on the individual.

It was made clear from the start that Rear Window would assume curatorial role on the project, which meant that workshop users willing to develop their ideas within the context of the project also had to face a process of evaluation and assessment. No matter how sensitively this was undertaken, and its was certainly handled with insight and respect for each individual, the implications and attendant anxieties had to be confronted and worked through by every participant.

From the clinical point of view, such interventions could be understood as presenting valuable opportunities for users to negotiate new relationships with “outsiders,” while at the same time engaging in the painful process of what is termed “reality testing” through subjecting their ideas, and therefore aspects of themselves, to a professional response. Opportunities for personal development of this kind are limited within mental health care, and Rear Window’s initiatives were both supported and appreciated.

Additionally, the invitation to exhibit selections of the work made in the workshop programme or to tell their own stories through interviews, was highly valued by the hospital users. It is hoped that by creating a context within which hospital users can articulate their responses to the institution and all that it implies, alongside professional artists engaged in a similar task, a conversational space has been opened up. This offers ways for all participants to re-locate themselves within a general cultural and societal arena and, through this process to challenge further the fixed positions each occupies within an established discourse attached to a particular institution.

In reflecting on my role in the project, I became aware of how difficult it was to maintain distinct boundaries between my ongoing work as a clinician at Hackney Hospital and my involvement on the Care and Control project. From the beginning, Jane and I provided the essential links between Rear Window, the hospital users and the hospital staff and management. A large number of the service users who participated in the project had been or are currently members of one of my art therapy groups, and have experienced my only within this context. As an art therapist, I have been in the privileged position of having access to conversations which are rightly considered personal and confidential, the content of which has no place in a project like Care and Control. For hospital users to engage with me, and through me, with professional on the Care and Control project, opened up another dimension to the therapeutic relationship I had established with them.

This kind of development can be very healthy, providing that the therapist and the client are both aware of the subtle dividing lines, which help to differentiate one form of interaction from another. The willingness to be flexible and to take risks within a relationship which seems to have clear parameters, was generously demonstrated by those hospital users with whom I had had long term contact and who took part in Care and Control. From my current position it is impossible to know—if indeed it ever will be—the degree to which the experience was predominantly positive or negative for some of the more vulnerable individual involved. On a general note, such risks are inherent in any new and innovative undertaking of this kind, and at this stage, it would seem that the gains have far exceeded the losses.

Shifting away from the clinical perspective, another area of concern for me pivoted on my identity as an artist, and whether or not I would be able to create a piece of work for the exhibition. The problem I faced was that of identifying a conceptual focus, given the fact that individuals currently in therapy with me would see the exhibition. It is the therapist’s responsibility to make it possible for the client to superimpose inner representations of figure from the past onto the therapist, that is, to provide the conditions for the development of the transference relationship. Through this process, the consciously forgotten past, and the attendant feelings, are re-enacted in the present. In order to facilitate this experience, it is most helpful if the client’s knowledge of the therapist’s core identity is limited. Making a piece of art implicitly involves degrees of disclosure, both through revealing the conceptual concerns of the artists and through the formal structure, or the language employed. This made thinking of a possible contribution to the show very problematic, and serves to illustrate further the conflict between my role as artist and art therapist.

Jane faced a similar dilemma; we both felt strongly, however, that it was crucial to challenge the way in which the contemporary art establishment tends to restrict how an artist’s practice is identified. It would seem that the artist is commonly viewed as an individual who produces pieces, which can be shown within a gallery setting. Although this model is constantly being questioned in many different ways by artists, curators, and critics, Jane and I wished to develop the debate within the context of our positions within the hospital.

Our mutual conviction is that the work we undertake in planning and facilitating workshops and exhibitions for hospital users I in itself a form of art practice. The discussions between ourselves, and with hospital users, evolve out of questions similar to those pose by artists who regularly exhibit: who is the art being made for? Can the role of the artist be opened up to include individuals who operate outside the fixed boundaries established and, some might say, actively protected by the art community? Is there a role for art outside the gallery setting? What or who defines whether or not a piece of work is in fact art? The pieces that Jane and I chose to install for the exhibition represent our collaborative attempt to address these issues.

It seems important to confirm that it has never been our intention to “elevate” the work created by hospital users to the status of so-termed “high art.” Rather, we continue to attempt to question the ways in which space is made available for selected individuals (artists) to articulate their responses to pertinent political, social, and cultural concerns shared by the community as a whole. Often artists take on the role of interpreter or advocate for those who are not in the privileged position of being able to develop their own language. Through the workshop programme, Jane and I have attempted to open up a creative space in which the acquisition of visual language skills can be fostered and, inseparable from this, new ways of thinking can be developed. Rear Window’s significant contribution to this undertaking has taken the process one step further.